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Urinary incontinence in men

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Updated 2024 AUA/GURS/SUFU guidelines for the management of urinary incontinence in men after prostate treatment.

Guidelines

Key sources

The following summarized guidelines for the evaluation and management of urinary incontinence in men are prepared by our editorial team based on guidelines from the American Academy of Family Physicians (AAFP 2024), the Society of Genitourinary Reconstructive Surgeons (GURS/AUA/SUFU 2024), the European Association of Urology (EAU 2022), and the American Urological Association (AUA/SUFU 2019,2012).
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Diagnostic investigations

History and physical examination: as per EAU 2022 guidelines, elicit a complete medical history including symptoms and comorbidities, medications, and perform a focused physical examination in the evaluation of male patients with UI.
A
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  • Assessment of PVR

  • Urodynamic testing

  • Bladder EMG

Medical management

Antimuscarinic agents: as per EAU 2022 guidelines, offer antimuscarinic agents or mirabegron in adult patients with urge UI failed conservative treatment.
A

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  • Duloxetine

Nonpharmacologic interventions

Lifestyle modifications: as per EAU 2022 guidelines, offer lifestyle modifications for improving UI, although evidence is lacking.
B

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  • Incontinence pads

  • Bladder training

  • Prompted voiding

Therapeutic procedures

Intravesical injection of botulinum toxin
As per EAU 2022 guidelines:
Offer bladder wall injections of onabotulinumtoxin A (100 U) in patients with overactive bladder/urge UI refractory to medical therapy.
B
Inform patients about the limited duration of response, risk of UTI, and possible prolonged need for clean intermittent self-catheterization (ensure that they are willing and able to do so).
A

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  • Sacral nerve stimulation

  • Artificial urinary sphincter

  • Noncircumferential compression device

  • Indwelling urinary catheter

Surgical interventions

Augmentation cystoplasty
As per EAU 2022 guidelines:
Offer augmentation cystoplasty in patients with overactive bladder/urge UI refractory to all other treatment options and able and willing to perform self-catheterization.
B
Inform patients undergoing augmentation cystoplasty of the high risk of complications, the risk of having to perform clean intermittent self-catheterization, and the need for life-long surveillance.
A

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  • Urinary diversion

Specific circumstances

Patients after prostate treatment, preoperative counseling: as per AUA/GURS/SUFU 2024 guidelines, counsel patients undergoing localized prostate cancer treatment regarding all known factors that could affect continence
B
and the risk of sexual arousal incontinence and climacturia following localized prostate cancer treatment.
B

More topics in this section

  • Patients after prostate treatment (evaluation)

  • Patients after prostate treatment (pelvic floor muscle training)

  • Patients after prostate treatment (transobturator slings)

  • Patients after prostate treatment (artificial urinary sphincter)

  • Patients after prostate treatment (noncircumferential compression device)

  • Patients after prostate treatment (periurethral injection of bulking agents)

  • Patients after prostate treatment (surgery)

  • Patients after prostate treatment (management of persistent/recurrent incontinence)

  • Patients after prostate treatment (management of sexual dysfunction)